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Multidisciplinary Lipid Management for Prevention of Cardiovascular Risks - Episode 10

Implications for Prescribing Icosapent Ethyl to Prevent CVD

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Takeaways of the REDUCE-IT trial of icosapent ethyl as treatment for dyslipidemia and hypertriglyceridemia.

Dhiren Patel, PharmD, CDCES, BC-ADM, BCACP: I’d like to go around here because I think everyone, you were involved in the research side of it, and then now in the practice side, but Dr Busch, maybe if you can comment on that, and kind of what that looked like for you from the research side, now, how you’ve implemented that to the practice side and what that looks like. And we will go around the horn.

Robert Busch, MD: So, for the research side, as Dr Bhatt mentioned, it was very easy to find these patients. They were in front of us every day. And what was so unique in that study, you saw even though these patients were all on a statin with an LDL [low-density lipoprotein] in the mid-70s, it was a 28% rate of events over the 5 years on the statin already. It shows huge residual risk, and anything you could do to lower that residual risk. And that’s what we do all day long. We’re giving heart-smart diabetes drugs. We’re giving aggressive blood pressure drugs. So, as a clinician, you always want to do 1 better than you did before, as long as the drug is safe and affordable for the patient. So, of course, bringing in 4 capsules a day that are not small capsules on top of what the patient was on to treat something that’s a marker, because even if their triglycerides didn’t drop that much, it still had benefit. The trick is not only to initiate it, but to get the patient to stay on it because what do you do? You’re lowering heart attack, stroke, and death, and each individual parameter was lowered, which is very unusual in these cardiovascular trials. EMPEROR-Red lowered cardiac death but didn’t lower stroke. Some of the other trials, nothing was low in 1 thing, but all is a conglomerate here. Each individual factor was lowered, and that’s what’s so important with this. As I icosapent ethalized my patients over the 3 months after the study came out, you watch through your practice. Not of all of our partners do it. Dr Bhatt is running another study by another company with an EPA [eicosapentaenoic acid] S-drug. And it’s still easy to find these patients in my partner’s practices. And. as Jen mentioned earlier, where there’s a will, there’s a way. There’s a $9 copay card to get branded icosapent [Vascepa] and for $9 it’s worth having the discussion with the patient. And with our pharm D backup, we can get the drug into the patient that’s affordable. That lowers their event rate, which is pretty dramatic.

Dhiren Patel, PharmD, CDCES, BC-ADM, BCACP: That makes sense. And I have a pressing question for Jen, but Joyce, what has this done for you guys in your practice, where you’ve been very hyper focused on all of the newer agents that come and monitoring this from a clinical practice standpoint, what does this look like for you from a prescribing standpoint now?

Joyce Ross, MSN, RNC, CRNP, CS, FNLA, FPCNA: I think the most important thing is that it really solidified the fact that it’s not just about LDL cholesterol as Dr Bhatt very elegantly discussed. And I think that what has [been] very frustrating for patients over time is to get that LDL cholesterol down that we’ve been harboring on and pushing and raising amazing medications to get there, and yet they still have other vascular events. For many years, Dan Rader [Daniel J. Rader, MD, FAHA, University of Pennsylvania] and I thought that there’s something about these triglycerides. While I couldn’t put my finger on it and while we didn’t have the research that we have now, I was sure there was something with triglyceride that had something to do with the inflammation and the oxidation of the LDL cholesterol. When you start to talk to a patient about you’re really doing—you’re doing well, and what if we could add something that was going to change [the] outcome for you toward the next event by 25%? Well, as you go back to what Bob said earlier, that’s double, double, double, double, all the statins. And here you go with 1 addition. Yes, it’s 4 pills, but that’s a major outcome. And what you’re doing is treating all the [I have no clue] particles. For me that’s what’s important. And helping a patient who’s so frustrated that they continue to have events going to other vascular beds that there’s something to do and we know it’s not just about the LDL.

Transcript edited for clarity.